Who needs NPI?
NPI or National Provider Identifier is a 10 digit unique number that is assigned to any individual or organization that meets the definition of health care provider as described at 45 CFR 160.103. It is like a diamond and will last forever. It is an Administrative Simplification mandate of HIPAA. Anyone who is a HIPPA covered provider or any health care provider who bills Medicare for their services needs an NPI.
Why you should get an NPI?
If your office is doing any HIPAA-related regular electronic transactions, an NPI is required. Verifying enrollee eligibility, verifying enrollee benefits, uploading electronic claims (online or via a clearinghouse), and testing your claim status are some of the main activities requiring an NPI. You should probably consider having one soon if you do not have your NPI yet. Below we have mentioned few points why getting an NPI is always a good idea.
- Getting an NPI is a simple and easy task. Moreover, it is free and you do not need to pay for it.
- It is a mandated HIPAA standard, and because it should simplify billing.
- NPI is a single identifying number of the insurer that all insurance plans can acknowledge and recognize.
- Recognized as a valid identifier by all insurance carriers, which contributes to more efficient coordination of benefits
Generally, there are two types of NPI and these are Type 1 and Type 2
Which Type of NPI Do I Need?
Type 1 of NPI is for those who practice solo health care services such as dentist and hygienists. If you collect payments under your name or your social security number as a solo practitioner, this is the only form of NPI you need.
Type 2 is for community practices, integrated dental practices, or other business groups paying under their company or company name or their employer identification number (EIN).
Generally, Type 1 NPI is needed for each provider, and Type 2 is needed for each business (e.g., separate TIN#).
The NPI is an Administrative Simplification mandate of HIPAA. It is compulsory to have an NPI if you are a HIPAA-covered entity else you can be fined with a heavy penalty.